Draft of the Political Declaration on HIV and AIDS disappoints public health NGOs

NYC, 7 PM Wed, June 8, 2011.

Several UN officials, public health NGOs and developing country negotiators are disappointed at the weak language on access to medicines for HIV/AIDS in a draft of the Political Declaration on HIV and AIDS. According to one country negotiator, it’s a step backwards from previous declarations. There is no mention of the WHO Global Strategy on Public Health, Innovation and Intellectual Property Rights (WHA61.21), no mention of the de-linkage of R&D costs from drug prices, a call for adoption of 31 bis of the TRIPS, weak language on restrictive IPR provisions in bilateral trade agreements, no support for the extension of the TRIPS waiver for least developed countries, and at best a vague reference to the goods in transit issue that resulted in the seizure of legitimate generic drugs in Europe.

The Obama Administration was said to have been particularly aggressive in watering down provisions that were opposed by the pharmaceutical trade association PhRMA. There was also concern that many developing countries had been fairly soft in the negotiations, and not pressed on the tougher issues relating to access.

On the funding issues, earlier attempts to include specific funding commitments have apparently failed.

Today’s draft of the declaration is more than 100 paragraphs, and covers a lot of ground on many issues. This is a copy of the draft the is being read this evening in New York. The final declaration will be voted on Friday.

The draft declaration:

Political Declaration on HIV and AIDS
Intensifying Our Efforts to Eliminate HIV and AIDS

1. We, Heads of State and Government and representatives of States and Governments assembled
at the United Nations from 8 to 10 June 2011 to review progress achieved in realizing the
2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on
HIV/AIDS, with a view to guiding and intensifying the global response to HIV and AIDS by
promoting continued political commitment and engagement of leaders in a comprehensive
response at community, local, national, regional and international levels to halt and reverse the
HIV epidemic and mitigate its impact;

2. Reaffirm the sovereign rights of Member States, as enshrined in the United Nations Charter,
and the need for all countries to implement the commitments and pledges in this declaration
consistent with national laws, national development priorities and international human rights;

3. Reaffirm the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political
Declaration on HIV/AIDS and the urgent need to scale up significantly our efforts towards the
goal of universal access to comprehensive prevention programmes, treatment, care and

4. Recognize that, although HIV and AIDS are affecting every region of the world, each
country’s epidemic is distinctive in terms of drivers, vulnerabilities, aggravating factors, and
populations affected, and therefore the responses from both the international community and
the countries themselves must be uniquely tailored to each particular situation taking into
account the epidemiological and social context of each country concerned;

5. Acknowledge the significance of this meeting which marks three decades since the first report
of AIDS; ten years since the adoption of the Declaration of Commitment on HIV/AIDS and its
time-bound measurable goals and targets; and five years since the adoption of the Political
Declaration on HIV/AIDS and its commitment to urgently scale up towards achieving the goal
of universal access to comprehensive prevention programmes, treatment, care and support by

6. Reaffirm our commitment to the achievement of all the Millennium Development Goals, in
particular MDG 6, and recognizing the importance of rapidly scaling up efforts to integrate
HIV and AIDS prevention, treatment, care and support with efforts to achieve these goals, and
in this regard welcome the outcome of the 2010 United Nations Summit on the Millennium
Development Goals entitled “Keeping the promise: united to achieve the Millennium
Development Goals”;

7. Recognize that HIV and AIDS constitute a global emergency and pose one of the most
formidable challenges to the development, progress and stability of our respective societies
and the world at large, and require an exceptional and comprehensive global response that
takes into account that the spread of HIV is often a consequence and cause of poverty;

8. Note with deep concern that despite substantial progress over three decades since AIDS was
first reported, the HIV epidemic remains an unprecedented human catastrophe inflicting
immense suffering on countries, communities and families throughout the world; that more
than 30 million people have died from AIDS, with another estimated 33 million people living
with HIV; that more than 16 million children have been orphaned because of AIDS; that over
7000 new HIV infections occur every day, mostly among people in low- and middle-income
countries; and that less than half of people living with HIV are believed to be aware of their

9. Reiterate with profound concern that Africa, in particular sub-Saharan Africa, remains the
worst-affected region, and that urgent and exceptional action is required at all levels to curb
the devastating effects of this epidemic, and recognize the renewed commitment by African
governments and regional institutions to scale up their own HIV and AIDS responses;

10. Express deep concern that HIV and AIDS affect every region of the world, that the Caribbean
continues to have the highest prevalence outside of sub-Saharan Africa while the number of
new HIV infections is increasing in Eastern Europe and Central Asia, North Africa and the
Middle East, and parts of Asia and the Pacific;

11. Welcome the leadership and commitment shown in every aspect of the HIV and AIDS
response by governments, people living with HIV, political and community leaders,
parliaments, regional and subregional organizations, communities, families, faith-based
organizations, scientists and health professionals, donors, the philanthropic community, the
workforce, the business sector, civil society and the media;

12. Welcome the exceptional efforts at national, regional and international levels to implement the
2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on
HIV/AIDS and the important progress being achieved, including a more than 25 per cent
reduction in the rate of new HIV infections in over 30 countries; the significant reduction in
mother-to-child transmission of HIV; and the unprecedented expansion of access to HIV
antiretroviral treatment to over 6 million people, resulting in the reduction of AIDS-related
deaths by more than 20 per cent in the past five years;

13. Recognize that the worldwide commitment to the global HIV epidemic has been
unprecedented since the 2001 Declaration of Commitment on HIV/AIDS and the 2006
Political Declaration on HIV/AIDS, represented by an over eight-fold increase in funding from
$1.8 billion in 2001 to $16 billion in 2010, the largest amount dedicated to combating a single
disease in history;

14. Express deep concern that funding devoted to HIV and AIDS responses is still not
commensurate with the magnitude of the epidemic either nationally or internationally, and that
the global financial and economic crises continue to have a negative impact on the HIV and
AIDS response at all levels, including the fact that for the first time, international assistance
did not increase from 2008 – 2009 levels; and in this regard welcome the increased resources
that are being made available as a result of the establishment of timetables by many developed
countries to achieve the targets of 0.7 per cent of gross national product for official
development assistance by 2015, stressing also the importance of complementary innovative
sources of financing, in addition to traditional funding, including official development
assistance to support national strategies, financing plans and multilateral efforts aimed at
combating HIV and AIDS;

15. Stress the importance of international cooperation including the role of North-South, South-
South and triangular cooperation in the global response to HIV and AIDS, bearing in mind that
South-South cooperation is not a substitute for, but rather a complement to, North-South
cooperation, and recognize the shared but differentiated responsibilities and respective
capacities of governments, donor countries, as well as civil society, including the private
sector, while noting that national ownership and leadership are absolutely indispensable in this

16. Commend the Secretariat and the Co-sponsors of the Joint United Nations Programme on
HIV/AIDS for their leadership role on HIV and AIDS policy and coordination, and for the
support they provide to countries through the Joint Programme;

17. Commend the Global Fund to Fight AIDS, Tuberculosis and Malaria for the vital role it is
playing in mobilizing and providing funding for national and regional HIV and AIDS
responses, and improving the predictability of financing over the long-term, and welcome the
commitment of over US$30 billion in funding from donors to date including the significant
pledges made by donors at the 2010 Global Fund replenishment meeting; note with concern
that while these pledges represented an increase in financing, they fell short of the amounts
targeted by the Global Fund to further accelerate progress towards universal access; and
recognize that to reach that goal it is imperative that the Global Fund’s work be supported and
also that it be adequately funded;

18. Commend as well the work of UNITAID based on innovative financing and focusing on
accessibility, quality and price-reduction of antiretroviral drugs;

19. Welcome the Secretary-General’s Global Strategy for Women’s and Children’s Health,
undertaken by a broad coalition of partners, in support of national plans and strategies, in
order to significantly reduce the number of maternal, newborn and under-five child deaths as a
matter of immediate concern, including by scaling up a priority package of high-impact
interventions and integrating efforts in sectors such as health, education, gender equality,
water and sanitation, poverty reduction and nutrition;

20. Recognize that agrarian economies are heavily affected by HIV and AIDS which debilitate
their communities and families with negative consequences for poverty eradication, and that
people die prematurely from AIDS because, inter alia, poor nutrition exacerbates the impact of
HIV on the immune system and compromises its ability to respond to opportunistic infections
and diseases, and that HIV treatment, including antiretroviral treatment, should be
complemented with adequate food and nutrition;

21. Remain deeply concerned that globally women and girls are still the most affected by the
epidemic and that they bear a disproportionate share of the care-giving burden and that the
ability of women and girls to protect themselves from HIV continues to be compromised by
physiological factors, gender inequalities including unequal legal, economic and social status,
insufficient access to healthcare and services, including for sexual and reproductive health and
all forms of discrimination and violence, including sexual violence and exploitation against

22. Welcome the establishment of UN Women as a new stakeholder that can play an important
role in global efforts to combat HIV by promoting gender equality and the empowerment of
women, which are fundamental for reducing their vulnerability to HIV; and the appointment
of its first Executive Director;

23. Welcome the adoption of the UN Convention on the Rights of Persons with Disabilities, and
recognize the need to take into account the rights of persons with disabilities as set forth in
that Convention, in particular with regard to health, education, accessibility and information,
in the formulation of our global response to HIV and AIDS;

24. Note with appreciation the efforts of the Inter-Parliamentary Union in supporting national
parliaments to ensure an enabling legal environment supportive of effective national responses
to HIV and AIDS;

25. Express grave concern that young people aged 15 to 24 account for more than one third of all
new HIV infections, with some 3000 young people becoming infected with HIV each day;
note that most young people still have limited access to good quality education, decent
employment, and recreational facilities, as well as limited access to sexual and reproductive
health programmes that provide the information, skills, services and commodities they need to
protect themselves; that only 34% of young people possess accurate knowledge of HIV; and
that laws and policies in some instances exclude young people from accessing sexual
healthcare and HIV-related services such as voluntary and confidential HIV-testing,
counselling and age-appropriate sex and HIV prevention education; while also recognizing the
importance of reducing risk taking behaviour and encouraging responsible sexual behaviour,
including abstinence, fidelity and correct and consistent use of condoms;

26. Note with alarm the rise in the incidence of HIV among people who inject drugs and that
despite continuing increased efforts by all relevant stakeholders, the drug problem continues to
constitute a serious threat to, among others, public health and safety and the well-being of
humanity, in particular children and young people and their families; and recognize that much
more needs to be done to effectively combat the world drug problem;

27. Recall our commitment that prevention must be the cornerstone of the global HIV and AIDS
response, but note that many national HIV prevention programmes and spending priorities do
not adequately reflect this commitment; that HIV prevention spending is insufficient to mount
a vigorous, effective, comprehensive global HIV prevention response; that national prevention
programmes are often not sufficiently coordinated and evidence-based; and that prevention
strategies do not adequately reflect infection patterns or sufficiently focus on populations at
higher risk of HIV; and that only 33 per cent of countries have prevalence targets for young
people and only 34 per cent have specific goals in place for condom programming;

28. Note with concern that national prevention strategies and programmes are often too generic in
nature and do not adequately respond to infection patterns and the disease burden; for example,
where heterosexual sex is the dominant mode of transmission, married or cohabitating
individuals, including those in sero-discordant relationships, account for the majority of new
infections but they are not sufficiently targeted with testing and prevention interventions;

29. Note that many national HIV prevention strategies inadequately focus on populations that
epidemiological evidence shows are at higher risk, specifically men who have sex with men,
people who inject drugs and sex workers, and further note however that each country should
define the specific populations that are key to its epidemic and response, based on the
epidemiological and national context;

30. Note with grave concern that despite the near elimination of mother-to-child transmission of
HIV in high-income countries and the availability of low-cost interventions to prevent
transmission, approximately 370 000 infants were estimated to have been infected with HIV in

31. Note with concern that prevention, treatment, care and support programmes have been
inadequately targeted or made accessible to persons with disabilities;

32. Recognize that access to safe, effective, affordable, good-quality medicines and commodities
in the context of epidemics such as HIV are fundamental to the full realization of the right of
everyone to enjoy the highest attainable standard of physical and mental health;

33. Express grave concern that the majority of low- and middle-income countries did not meet
their universal access to HIV treatment targets despite the major achievement of expansion in
providing access to antiretroviral treatment to over 6 million people living with HIV in low-
and middle-income countries; that there are at least 10 million people living with HIV who are
medically-eligible to start antiretroviral treatment now; that discontinued treatment is a threat
to treatment efficacy; and that the sustainability of providing life-long HIV treatment is
threatened by factors such as poverty, lack of access to treatment and insufficient and
unpredictable funding; and by the number of new HIV infections outpacing the number of
people starting HIV treatment by a factor of two to one;

34. Recognize the pivotal role of research in underpinning progress in HIV prevention, treatment,
care and support and welcome the extraordinary advances in scientific knowledge about HIV
and its prevention and treatment; but note with concern that most new treatments are not
available or accessible in low-and middle-income countries and even in developed countries
there are often significant delays in accessing new HIV treatments for people not responding
to currently available treatment; and affirm the importance of social and operational research
in improving our understanding of factors which influence the epidemic and actions which
address it;

35. Recognize the critical importance of affordable medicines, including generics in scaling up
access to affordable HIV treatment; and further recognize that intellectual property rights
protection and enforcement measures should be TRIPS compliant and should be interpreted
and implemented in a manner supportive of Member States’ right to protect public health and,
in particular, to promote access to medicines for all;

36. Note with concern that regulations, policies and practices, including those that limit legitimate
trade of generic medicines, may seriously limit access to affordable HIV treatment and other
pharmaceutical products in low-and middle-income countries and recognize that
improvements can be made, inter alia, through national legislation, regulatory policy and
supply chain management; noting that reductions in barriers to affordable products could be
explored in order to expand access to affordable and good quality HIV prevention products,
diagnostics, medicine and treatment commodities for HIV including for opportunistic
infections and co-infections;

37. Recognize that there are additional means to reverse the global epidemic and avert millions of
HIV infections and AIDS-related deaths, and in this context we recognize that there is new
and potential scientific evidence available that could contribute to the effectiveness and
scaling up of prevention, treatment, care and support programmes;

38. Reaffirm the commitment to fulfil obligations to promote universal respect for and the
observance and protection of all human rights and fundamental freedoms for all in accordance
with the Charter, the Universal Declaration of Human Rights and other instruments relating to
human rights and international law; emphasize the importance of cultural, ethical and religious
values, the vital role of the family and the community and in particular people living with and
affected by HIV, including their families, and the need to take into account the particularities
of each country, in sustaining national HIV and AIDS responses, reaching all people living
with HIV, delivering HIV prevention, treatment, care and support, and strengthening health
systems in particular primary healthcare;

39. Reaffirm that the full realization of all human rights and fundamental freedoms for all is an
essential element in the global response to the HIV epidemic, including in the areas of
prevention, treatment, care and support, and recognize that addressing stigma and
discrimination against people living with, presumed to be living with or affected by HIV,
including their families, is also a critical element in combating the global HIV epidemic; and
recognize the need, as appropriate, to strengthen national policies and legislation to address
such stigma and discrimination;

40. Recognize that close co-operation with people living with HIV and populations at higher risk
of HIV infection will facilitate the achievement of a more effective HIV and AIDS response,
and emphasize that people living with and affected by HIV, including their families, should
enjoy equal participation in social, economic and cultural activities, without prejudice and
discrimination, and that they have equal access to healthcare and community support as all
members of the community;

41. Recognize that the access to sexual and reproductive health has been and continues to be
essential to HIV and AIDS responses, and that governments have the responsibility to provide
for public health, with special attention to families, women and children;

42. Recognize the importance of strengthening health systems, in particular primary healthcare
and the need to integrate the HIV and AIDS response into it, and note that weak health
systems, which already face many challenges including lack of trained and retention of skilled
health workers, are among the biggest barriers to access HIV and AIDS-related services;

43. Reaffirm the central role of the family, bearing in mind that in different cultural, social and
political systems various forms of the family exist, in reducing vulnerability to HIV, inter alia,
in educating and guiding children and take account of cultural, religious and ethical factors, to
reduce the vulnerability of children and young people by ensuring access of both girls and
boys to primary and secondary education, including HIV and AIDS in curricula for
adolescents; ensuring safe and secure environments especially for young girls; expanding
good-quality youth-friendly information and sexual health education and counselling services;
strengthening reproductive and sexual health programmes; and involving families and young
people in planning, implementing and evaluating HIV and AIDS prevention and care
programmes, to the extent possible;

44. Recognize the role that community organizations play, including those run by people living
with HIV, in sustaining national and local HIV and AIDS responses, reaching all people living
with HIV, delivering prevention, treatment, care and support related-services and
strengthening health systems, in particular the primary healthcare approach;

45. Acknowledge that the current trajectory of costs of HIV programmes is not sustainable and that
programmes must become more cost-effective, evidence-based and deliver better value-for6
money and that poorly coordinated and transaction-heavy responses and lack of proper
governance and financial accountability impede progress;

46. Note with concern that evidence-based responses, which must be informed by incidence and
prevalence disaggregated data, including by age, sex, and mode of transmission, continue to
require stronger measuring tools, data management systems, and improved monitoring and
evaluation capacity at the national and regional levels;

47. Note the relevant UNAIDS and WHO strategies on HIV and AIDS;

48. Recognize that the deadlines for achieving key targets and goals set out in the 2001
Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS
have now expired, while noting with deep concern that many countries have been unable to
fulfil their pledges to achieve them, and stress the urgent need to recommit to those targets and
goals, and commit to new, ambitious and achievable targets and goals building on the
impressive advances of the past ten years and addressing barriers to progress and new
challenges through a revitalized and enduring HIV and AIDS response;

49. Therefore, we solemnly declare our commitment to end the epidemic with renewed political
will and strong, accountable leadership and to work in meaningful partnership with all
stakeholders at all levels to implement bold and decisive actions as follows, taking into
account the diverse situations and circumstances in different countries and regions throughout
the world:

Leadership – Uniting to End the HIV Epidemic

50. Commit to seize this turning point in the HIV epidemic and through decisive, inclusive and
accountable leadership to revitalize and intensify the comprehensive global HIV and AIDS
response by recommitting to the commitments made in the 2001 Declaration of Commitment
on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS and by fully implementing the
commitments, goals and targets contained in this Declaration;

51. Commit to redouble efforts to achieve, by 2015, universal access to HIV prevention, treatment,
care and support as a critical step towards ending the global HIV epidemic, with a view to
achieving Millennium Development Goal 6, in particular to halt and begin to reverse by 2015
the spread of HIV;

52. Reaffirm our determination to achieve all the Millennium Development Goals, in particular
MDG 6, and recognize the importance of rapidly scaling up efforts to integrate HIV
prevention, treatment, care and support with efforts to achieve these goals;

53. Pledge to eliminate gender inequalities, gender-based abuse and violence; increase the
capacity of women and adolescent girls to protect themselves from the risk of HIV infection,
principally through the provision of health care and services, including, inter alia, sexual and
reproductive health, and the provision of full access to comprehensive information and
education; ensure that women can exercise their right to have control over, and decide freely
and responsibly on, matters related to their sexuality in order to increase their ability to protect
themselves from HIV infection, including their sexual and reproductive health, free of
coercion, discrimination and violence; and take all necessary measures to create an enabling
environment for the empowerment of women and strengthen their economic independence;
and in this context, reiterate the importance of the role of men and boys in achieving gender

54. Commit by 2012 to update and implement, through inclusive, country-led and transparent
processes, multi-sectoral national HIV and AIDS strategies and plans, including financing
plans, which include time bound goals to be reached in a targeted, equitable and sustained
manner to accelerate efforts to achieve universal access to HIV prevention, treatment, care and
support by 2015; and address unacceptably low prevention and treatment coverage;

55. Commit to increase national ownership of HIV and AIDS responses while calling on the
United Nations system, donor countries, the Global Fund to Fight AIDS, TB and Malaria, the
business sector and other international and regional organizations, to support Member States in
ensuring that nationally driven, credible, costed, evidence-based, inclusive and comprehensive
national HIV and AIDS strategic plans are, by 2013, funded and implemented with
transparency, accountability, and effectiveness in line with national priorities;

56. Commit to encouraging and supporting the active involvement and leadership of young people,
including those living with HIV, in the fight against the epidemic at local, national and global
levels; and agree to work with these new leaders to help develop specific measures to engage
young people about HIV, including in communities, families, schools, tertiary institutions,
recreation centres and workplaces;

57. Commit to continue engaging people living with and affected by HIV in decision making,
planning, implementing and evaluating the response and to partner with local leaders and civil
society, including community-based organizations, to develop and scale up community-led
HIV services and to address stigma and discrimination;

Prevention – Expand Coverage, Diversify Approaches and Intensify Efforts to End New HIV

58. Reaffirm that prevention of HIV must be the cornerstone of national, regional and international
responses to the HIV epidemic;

59. Commit to redouble HIV prevention efforts by taking all measures to implement
comprehensive, evidence-based prevention approaches, taking into account local
circumstances, ethics and cultural values, including through but not limited to:
a) conducting public awareness campaigns as well as targeted HIV education to raise public
awareness about HIV;

b) harnessing the energy of young people in helping to lead global HIV awareness;

c) reducing risk taking behaviour and encouraging responsible sexual behaviour including abstinence, fidelity and consistent and correct use of condoms;

d) expanding access to essential commodities, particularly male and female condoms and sterile injecting equipment;

e) ensuring that all people, particularly young people, have the means to exploit the potential of new modes of connection and communication;

f) significantly expanding and promoting voluntary and confidential HIV testing and counselling and provider-initiated HIV testing and counselling;

g) intensifying national testing promotion campaigns for HIV and other sexually transmitted infections;

h) give consideration, as appropriate, to implementing and expanding risk and harm reduction programmes, taking into account the “WHO/UNODC/UNAIDS Technical Guide for Countries to set targets for universal access to HIV prevention, treatment, care for injecting drug users” in accordance with national legislation;

i) promoting medical male circumcision where HIV prevalence is high and male circumcision rates low;

j) sensitizing and encouraging the active engagement of men and boys in promoting gender equality;

k) facilitating access to sexual and reproductive healthcare services;

l) ensuring that women of child-bearing age have access to HIV prevention-related services and that pregnant women have access to antenatal care, information, counselling and other HIV services and to increasing the availability of and access to effective treatment to women living with HIV and infants;

m) strengthening evidence-based health sector prevention interventions including in rural and hard to reach places; and

n) deploying new biomedical interventions as soon as they are validated, including female-initiated prevention methods such as microbicides; HIV treatment prophylaxis; earlier treatment as prevention; and an HIV vaccine;

60. Commit to ensure that financial resources for prevention are targeted to evidence-based
prevention measures that reflect the specific nature of each country’s epidemic by focusing on
geographic locations, social networks and populations vulnerable to HIV infection, according
to the extent to which they account for new infections in each setting, in order to ensure that
resources for HIV prevention are spent as cost-effectively as possible; and ensuring particular
attention is paid to women and girls, young people, orphans and vulnerable children, migrants
and people affected by humanitarian emergencies, prisoners, indigenous people and people
with disabilities, depending on local circumstances;

61. Commit to ensure that national prevention strategies comprehensively target populations at
higher risk; ensure that systems of data collection and analysis about these populations are
strengthened; and take measures to ensure that HIV services, including voluntary and
confidential HIV testing and counselling, are accessible to these populations so that they are
encouraged to access HIV prevention, treatment, care and support;

62. Commit to working towards reducing sexual transmission of HIV by 50 per cent by 2015;

63. Commit to working towards reducing transmission of HIV among people who inject drugs by
50 per cent by 2015;

64. Commit to working towards the elimination of mother-to-child transmission of HIV by 2015
and substantially reducing AIDS-related maternal deaths;

Treatment, Care and Support – Eliminating AIDS-related Illness and Death

65. Pledge to intensify efforts that will help increase the life expectancy and quality of life of all
people living with HIV;

66. Commit to accelerate efforts to achieve the goal of universal access to antiretroviral treatment
for those eligible based on WHO HIV treatment guidelines that indicate timely initiation of
quality assured treatment for its maximum benefit, with the target of working towards 15
million people living with HIV on antiretroviral treatment by 2015;

67. Commit to support the reduction of unit costs and improve HIV treatment delivery including
through, inter alia, provision of good quality, affordable, effective, less toxic and simplified
treatment regimens that avert drug resistance; simple, affordable diagnostics at point-of-care;
cost reductions for all major elements of treatment delivery; mobilization and capacity
building of communities to support treatment scale-up and patient retention; programmes
which support improved treatment adherence; directing particular efforts towards hard-toreach
populations far from physical healthcare facilities and programmes and those in informal
settlement settings and other locations where healthcare facilities are inadequate; and
recognizing the supplementary prevention benefits from treatment alongside other prevention

68. Commit to develop and implement strategies to improve infant HIV diagnosis, including
through access to diagnostics at point-of-care; significantly increase and improve access to
treatment for children and adolescents living with HIV, including access to prophylaxis and
treatments for opportunistic infections, as well as increased support to children and adolescents
through increased financial, social and moral support for their parents, families and legal
guardians and promote a smooth transition from paediatric to young adult treatment and
related support and services;

69. Commit to promote services that integrate prevention, treatment and care of co-occurring
conditions including tuberculosis and hepatitis; improve access to quality, affordable primary
healthcare, comprehensive care and support services including those which address physical,
spiritual, psychosocial, socio-economic, and legal aspects of living with HIV; and palliative
care services;

70. Commit to take immediate action on the national and global levels to integrate food and
nutritional support into programmes directed to people affected by HIV, in order to ensure
access to sufficient, safe and nutritious food to enable people to meet their dietary needs and
food preferences, for an active and healthy life as part of a comprehensive response to HIV and

71. Commit to remove before 2015, where feasible, obstacles which limit the capacity of low- and
middle-income countries to provide affordable and effective HIV prevention and treatment
products, diagnostics, medicines and commodities and other pharmaceutical products as well
as treatment for opportunistic infections and co-infections, and to reduce costs associated with
life-long chronic care, including by amending national laws and regulations, as deemed
appropriate by respective governments, to optimize:

(a) The use, to the full, of existing flexibilities under the Trade-Related Aspects of
Intellectual Property Rights (TRIPS) Agreement specifically geared to promoting access
to and trade of medicines; and, while recognizing the importance of the intellectual
property rights regime in contributing towards a more effective AIDS response, ensure
that intellectual property rights provisions in trade agreements do not undermine these
existing flexibilities, as confirmed by the Doha Declaration on TRIPS Agreement and
Public Health, and call for early acceptance of the amendment to Article 31 of the TRIPS
Agreement, as adopted by the General Council of the World Trade Organization in its
decision of 6 December 2005;

(b) addressing barriers, regulations, policies and practices that prevent access to affordable
HIV treatment by promoting generic competition in order to help reduce costs associated
with life-long chronic care; and by encouraging all states to apply measures and
procedures for enforcing Intellectual Property Rights in such a manner as to avoid
creating barriers to the legitimate trade of medicines, and to provide for safeguards
against the abuse of such measures and procedures; and

(c) encouraging the voluntary use, where appropriate, of new mechanisms such as
partnerships, tiered pricing, open-source sharing of patents and patent pools benefitting
all developing countries, including through entities such as the Medicines Patent Pool, to
help reduce treatment costs and encourage development of new HIV treatment
formulations, including HIV medicines and point-of-care diagnostics, in particular for

72. Urge relevant international organizations, upon request and in accordance with the
organizations’ respective mandates, such as where appropriate, the World Intellectual Property
Organization, the United Nations Industrial Development Organization, the United Nations
Development Programme, the United Nations Conference on Trade and Development, the
World Trade Organization and the World Health Organization, to provide national
governments of developing countries with technical and capacity-building assistance for those
governments’ efforts to increase access to HIV medicines and treatment, in accordance with
national strategies of each government, consistent with, and including through the use of,
existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS)
Agreement, as confirmed by the Doha Declaration on TRIPS Agreement and Public Health;

73. Commit by 2015 to address factors that limit treatment uptake and contribute to treatment
stock-outs, drug production and delivery delays; inadequate storage of medicines, patient dropout,
including inadequate and inaccessible transportation to clinical sites; lack of accessibility
of information, resources and sites, especially to persons with disabilities; sub-optimal
management of treatment-related side effects; poor adherence to treatment; out-of-pocket
expenses for non-drug components of treatment; loss of income associated with clinic
attendance; and inadequate human resources for healthcare;

74. Call on pharmaceutical companies to take measures to ensure timely production and delivery
of affordable, good quality and effective antiretroviral medicines in order to contribute to
maintaining an efficient national system of distribution of these medicines;

75. Expand efforts to combat tuberculosis, which is a leading cause of death among people living
with HIV, by improving TB screening, TB prevention, access to diagnosis and treatment of TB
and drug-resistant TB and access to antiretroviral therapy, through more integrated delivery of
HIV and TB services in line with the Global Plan to Stop TB: 2011-2015; and commit by 2015
to work towards reducing TB deaths in people living with HIV by 50 per cent;

76. Commit to reduce the high rates of HIV and hepatitis B and C co-infection by developing as
soon as practicable an estimate of the global treatment need, increasing efforts towards the
development of a vaccination for hepatitis C and rapidly expanding access to appropriate
vaccination for hepatitis B and diagnostics and treatment of HIV and hepatitis co-infections;

Advancing Human Rights to Reduce Stigma, Discrimination and Violence related to HIV

77. Commit to intensify national efforts to create enabling legal, social and policy frameworks in
each national context in order to eliminate stigma, discrimination and violence related to HIV
and promote access to HIV prevention, treatment, care and support and non-discriminatory
access to education, healthcare, employment and social services; provide legal protections for
people affected by HIV including inheritance rights and respect for privacy and
confidentiality; and promote and protect all human rights and fundamental freedoms with
particular attention to all people vulnerable to and affected by HIV;

78. Commit to review, as appropriate, laws and policies which adversely impact on the successful,
effective and equitable delivery of HIV prevention, treatment, care and support programmes to
people living with and affected by HIV and consider their review in accordance with relevant
national review frameworks and timeframes;

79. Encourage Member States to consider identifying and reviewing, in order to eliminate, any
remaining HIV-related restrictions on entry, stay and residence;

80. Commit to national HIV and AIDS strategies that promote and protect human rights, including
programmes aimed at eliminating stigma and discrimination against people living with and
affected by HIV, including their families, including through sensitizing police and judges,
training health care workers in non-discrimination, confidentiality and informed consent,
supporting national human rights learning campaigns, legal literacy, and legal services, as well
as monitoring the impact of the legal environment on HIV prevention, treatment, care and

81. Commit to ensuring that national responses to HIV and AIDS meet the specific needs of
women and girls, including those living with and affected by HIV, across their lifespan
through strengthening legal, policy, administrative and other measures for the promotion and
protection of women’s full enjoyment of all human rights and the reduction of their
vulnerability to HIV through the elimination of all forms of discrimination, as well as all types
of sexual exploitation of women, girls and boys, including for commercial reasons, and all
forms of violence against women and girls, including harmful traditional and customary
practices, abuse, rape and other forms of sexual violence, battering and trafficking in women
and girls;

82. Commit to strengthen national social and child protection systems, and care and support
programmes for children, in particular for the girl child, and adolescents affected by and
vulnerable to HIV, as well as their families and caregivers, including through the provision of
equal opportunities to support the development to full potential of orphans and other children
affected by and living with HIV, especially through equal education access, the creation of
safe and non-discriminatory learning environments, supportive legal systems and protections
including civil registration systems, and provision of comprehensive information and support
to children and their families and caregivers, especially age-appropriate HIV information to
assist children living with HIV as they transition through adolescence, consistent with their
evolving capacities;

83. Commit to promoting laws and policies that ensure the full realization of all human rights and
fundamental freedoms for young people, particularly those living with HIV and those at higher
risk of HIV infection in order to eliminate the stigma and discrimination they face;

84. Commit to address, according to national legislation, the vulnerabilities to HIV experienced by
migrant and mobile populations and support their access to HIV prevention, treatment, care
and support;

85. Commit to mitigate the impact of the epidemic on workers, their families, their dependants,
workplaces and economies, including by taking into account all relevant ILO conventions,
as well as the guidance provided by the relevant ILO recommendations, including ILO
Recommendation No 200, and call on employers, trade and labour unions, employees and
volunteers to eliminate stigma and discrimination, protect human rights and facilitate access to
HIV prevention, treatment, care and support;

Resources for the AIDS response

86. Commit to working towards closing the global HIV and AIDS resource gap by 2015, currently
estimated by UNAIDS to be US$6 billion annually, through greater strategic investments,
continued domestic and international funding to enable countries to access predictable and
sustainable financial resources, sources of innovative financing and by ensuring that funding
flows through country finance systems, where appropriate and available, and is aligned with
accountable and sustainable national HIV and AIDS and development strategies that maximize
synergies and deliver sustainable programmes that are evidence-based and implemented with
transparency, accountability and effectiveness;

87. Commit to breaking the upward trajectory of costs through the efficient utilisation of resources,
addressing barriers to the legal trade of generics and other low-cost medicines, improving the
efficiency of prevention by targeting interventions to deliver more efficient, innovative and
sustainable programmes for the HIV and AIDS response in accordance with national
development plans and priorities, and ensuring that synergies are exploited between the HIV
and AIDS response and efforts to achieve the internationally agreed development goals,
including the Millennium Development Goals;

88. Commit by 2015, through a series of incremental steps and through our shared responsibility,
to reach a significant level of annual global expenditure on HIV and AIDS, while recognizing
that the overall target estimated by UNAIDS is between US$22 and US$24 billion in low- and
middle-income countries, by increasing national ownership of HIV and AIDS responses
through greater allocations from national resources and traditional sources of funding
including official development assistance;

89. Strongly urge those developed countries which have pledged to achieve the target of 0.7 per
cent of gross national product for official development assistance by 2015, and urge those
developed countries that have not yet done so, to take additional concrete efforts in this regard
to fulfil their commitments;

90. Strongly urge African countries which adopted the Abuja Declaration to take concrete
measures to meet the target of allocating at least 15% of their annual budget to the
improvement of the health sector, in accordance with the Abuja Declaration and Framework
for Action;

91. Commit to enhance the quality of aid by strengthening national ownership, alignment,
harmonization, predictability, mutual accountability and transparency, and results-orientation.

92. Commit to supporting and strengthening existing financial mechanisms, including the Global
Fund as well as relevant United Nations organizations, through the provision of funds in a
sustained and predictable manner, in particular to those countries with low- and middle-
income with high disease burden and/or a large number of people living with and affected by

93. Recommit to fully implementing the enhanced Heavily Indebted Poor Country (HIPC)
Initiative and agree to cancel all eligible bilateral official debts of qualified HIPC countries,
who reach the completion point under the initiative, in particular countries most affected by
HIV and AIDS, and urge the use of debt service savings, inter alia, to finance poverty
eradication programmes, particularly for prevention, treatment, care and support for HIV and
AIDS and other infections;

94. Commit to scaling up new, voluntary and additional innovative financing mechanisms to help
address the shortfall of resources available for the global HIV and AIDS response and to
improve the financing of the HIV and AIDS response over the long term; and commit to
accelerating efforts to identify innovative financing mechanisms that will generate additional
financial resources for HIV and AIDS, to complement national budgetary allocations and
official development assistance;

95. Appreciate that the Global Fund to Fight AIDS, Tuberculosis and Malaria is a pivotal
mechanism for achieving universal access to prevention, treatment, care and support by 2015;
recognize the Global Fund’s reform programme; and encourage Member States, the business
community, including foundations, and philanthropists to provide the highest level of support
for the Global Fund, taking into account the funding targets to be identified at the 2012 midterm
review of the Global Fund replenishment process;

Health Systems Strengthening and Integrating HIV and AIDS with Broader Health and

96. Commit to redouble efforts to strengthen health systems, including primary health care,
particularly in developing countries, through measures such as allocating national and
international resources; appropriate decentralization of HIV and AIDS programmes to improve
access for communities, including rural and hard-to-reach populations; integration of HIV and
AIDS programmes into primary health care, sexual and reproductive healthcare services and
specialized infectious disease services; improving planning for institutional, infrastructure and
human resource needs; improving supply chain management within health systems; increasing
human resource capacity for the response including by scaling up the training and retention of
human resources for health policy and planning, health care personnel, consistent with the
WHO voluntary “Global Code of Practice on the International Recruitment of Health
Personnel”, community health workers and peer educators; and with support from and in
partnership with international, regional organizations, the business sector and civil society, as

97. Support and encourage, through domestic and international funding and the provision of
technical assistance, the substantial development of human capital, development of national
and international research infrastructures, laboratory capacity, improved surveillance systems,
data collection, processing and dissemination; training basic and clinical researchers, social
scientists and technicians, with a focus on those countries most affected by HIV and/or
experiencing or at risk of a rapid expansion of the epidemic;

98. Commit by 2015 to working with partners to direct resources to and strengthen the advocacy,
policy and programmatic links between HIV and TB responses, primary health care services,
sexual and reproductive health, maternal and child health, hepatitis B and C, drug dependence,
non-communicable diseases and overall health systems; leverage healthcare services to prevent
mother-to-child transmission of HIV; strengthen interface between HIV services, related
sexual and reproductive healthcare and services, and other health services, including maternal
and child health; eliminate parallel systems for HIV-related services and information where
feasible; and strengthen linkages among national and global efforts concerned with human and
national development, including poverty eradication, preventative health, enhanced nutrition,
access to safe and clean drinking water, sanitation, education and the improvement of

99. Commit to supporting all national, regional and global efforts to achieve the Millennium
Development Goals, including those undertaken through North-South, South-South and
triangular cooperation, to improve comprehensive and integrated HIV prevention, treatment,
care and support programmes, as well as TB, sexual and reproductive health, malaria,
maternal and child health care;

Research and development – the key to preventing, treating and curing HIV

100. Commit to investing in accelerated basic research on the development of sustainable and
affordable HIV and TB diagnostics and treatments for HIV and its associated co-infections,
microbicides and other new prevention technologies, including female-controlled prevention
methods, rapid diagnostic and monitoring technologies, as well as biomedical, operations,
social, cultural and behavioural and traditional medicine research, and continue to build
national research capacity, especially in developing countries, through increased funding and
public-private partnerships, and create a conducive environment for research and ensure that it
is based on the highest ethical and scientific standards, and strengthening national regulatory

101. Commit to accelerate research and development for a safe, affordable, effective and accessible
vaccine and for a cure for HIV, while ensuring that sustainable systems for vaccine
procurement and equitable distribution are also developed;

Coordination, Monitoring and Accountability – Maximising the Response

102. Commit to having effective evidence-based operational, monitoring and evaluation, and mutual
accountability mechanisms between all stakeholders to support multi-sectoral national strategic
plans for HIV and AIDS to fulfil the commitments in this Declaration, with the active
involvement of people living with, affected by and vulnerable to HIV, and other relevant civil
society and private sector stakeholders;

103. Commit to revise by the end of 2012 the recommended framework of core indicators that
reflect the commitments made in the present Declaration and to develop additional measures,
where necessary, to strengthen national, regional and global coordination and monitoring
mechanisms of HIV and AIDS responses through inclusive and transparent processes with the
full involvement of member states and other relevant stakeholders, with the support of the
Joint United Nations Programme on HIV/AIDS;

Follow up – Sustaining progress

104. Encourage and support the exchange among countries and regions of information, research,
evidence and experiences related to implementing the measures and commitments related to
the global HIV and AIDS response and in particular those contained in this Declaration;
facilitate intensified North-South, South-South and triangular cooperation as well as regional,
subregional and interregional cooperation and coordination; and in this regard, continue to
encourage the United Nations Economic and Social Council to request the regional
commissions, within their respective mandates and resources to support periodic, inclusive
reviews of national efforts and progress made in their respective regions to combat HIV;

105. Request the Secretary-General of the United Nations to provide an annual report to the General
Assembly on progress achieved in realizing the commitments made in this Declaration; and,
with support from Joint United Nations Programme on HIV/AIDS, report progress to the
General Assembly in accordance with global reporting on Millennium Development Goals at
the 2013 Millennium Development Goals special event and subsequent Millennium
Development Goals reviews.